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Nicolau IA, Moineddin R, Brooks JD, Antoniou T, Gillis JL, Kendall CE, Cooper C, Cotterchio M, Salters K, Smieja M, Kroch AE, Price C, Mohamed A, Burchell AN. Associations of CD4 Cell Count Measures With Infection-Related and Infection-Unrelated Cancer Risk Among People With HIV. J Acquir Immune Defic Syndr 2024; 96:447-456. [PMID: 38985442 DOI: 10.1097/qai.0000000000003452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/09/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND People with HIV are at higher risk of infection-related cancers than the general population, which could be due, in part, to immune dysfunction. Our objective was to examine associations between 4 CD4 count measures as indicators of immune function and infection-related and infection-unrelated cancer risk. SETTING We conducted a cohort study of adults with HIV who were diagnosed with cancer in Ontario, Canada. Incident cancers were identified from January 1, 1997 to December 31, 2020. METHODS We estimated adjusted hazard ratios (aHR) for the associations between CD4 measures (baseline CD4, nadir CD4, time-updated CD4, time-updated CD4:CD8) and cancer incidence rates using competing risk analyses, adjusted for socio-demographic factors, history of hepatitis B or C infection, baseline viral load, smoking, and alcohol use. RESULTS Among 4771 people with HIV, contributing 59,111 person-years of observation, a total of 549 cancers were observed. Low baseline CD4 (<200 cells/µL) (aHR 2.08 [95% CI: 1.38 to 3.13], nadir (<200 cells/µL) (aHR 2.01 [95% CI: 1.49 to 2.71]), low time-updated CD4 (aHR 3.52 [95% CI: 2.36 to 5.24]) and time-updated CD4:CD8 ratio (<0.4) (aHR 2.02 [95% CI: 1.08 to 3.79]) were associated with an increased rate of infection-related cancer. No associations were observed for infection-unrelated cancers. CONCLUSIONS Low CD4 counts and indices were associated with increased rates of infection-related cancers among people with HIV, irrespective of the CD4 measure used. Early diagnosis and linkage to care and high antiretroviral therapy uptake may lead to improved immune function and could add to cancer prevention strategies such as screening and vaccine uptake.
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Affiliation(s)
- Ioana A Nicolau
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Jennifer D Brooks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tony Antoniou
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Claire E Kendall
- ICES, Toronto, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Curtis Cooper
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michelle Cotterchio
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Kate Salters
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | | | - Abigail E Kroch
- Ontario HIV Treatment Network, Toronto, Ontario, Canada; and
| | - Colleen Price
- Canadian HIV/AIDS and Chronic Pain Society, Ottawa, Ontario, Canada
| | - Anthony Mohamed
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Ann N Burchell
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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Dickey BL, Yanik EL, Thompson Z, Burkholder G, Kitahata MM, Moore RD, Jacobson J, Mathews WC, Christopoulos KA, Fleming J, Napravnik S, Achenbach C, Coghill AE. The Association of HIV Control and Immunosuppression With Risk of Non-AIDS-Defining Cancer Risk Among Patients on Antiretroviral Therapy. J Acquir Immune Defic Syndr 2024; 95:275-282. [PMID: 37977197 PMCID: PMC11146681 DOI: 10.1097/qai.0000000000003350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND People living with HIV (PWH) are experiencing an increased prevalence of non-AIDS-defining cancers (NADCs). Our study investigated the association of immunosuppression and HIV control with NADCs among PWH on antiretroviral therapy (ART) in the United States. METHODS Among patients across 8 clinical cohorts on ART between 1996 and 2016, we assessed immune function and HIV control using 3 parameterizations of CD4 count and HIV-RNA viral load (VL): (1) CD4 or VL at ART initiation; (2) change in CD4 or VL after ART initiation; and (3) proportion of follow-up time at CD4 >500 cells/µL or VL <50 copies/mL. Cox models were used to ascertain the association of these measures with risk of a viral NADC or nonviral NADC. RESULTS Among 29,568 patients on ART, there were 410 nonviral NADCs and 213 viral NADCs. PWH with a CD4 <200 cells/µL at ART initiation had an 80% elevated risk for developing a viral NADC. Each increase of 100 cells/µL in CD4 after ART initiation decreased risk by 14%. For viral and nonviral NADCs, 10% more follow-up time spent with a CD4 >500 cells/µL was associated with decreased risk [viral, adjusted hazard ratio (aHR): 0.82; 95% confidence intervals (CI): 0.78 to 0.86; nonviral, aHR: 0.88; 95% CI: 0.86 to 91], even after accounting for CD4 at ART initiation. When examining HIV control only, 10% more time with VL <50 copies/mL was significantly associated with decreased viral (aHR: 0.85; 95% CI: 0.82 to 0.89) and nonviral NADC risk (aHR: 0.88; 95% CI: 0.85 to 0.90). CONCLUSIONS This study demonstrates that even for PWH on ART therapy, maintaining HIV control is associated with lower risk of both viral and nonviral NADCs.
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Affiliation(s)
- Brittney L. Dickey
- Center for Immunization and Infection Research in Cancer & Department of Cancer Epidemiology, Moffitt Cancer Center
| | | | - Zachary Thompson
- Center for Immunization and Infection Research in Cancer & Department of Cancer Epidemiology, Moffitt Cancer Center
| | | | | | | | | | | | | | | | | | | | - Anna E. Coghill
- Center for Immunization and Infection Research in Cancer & Department of Cancer Epidemiology, Moffitt Cancer Center
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Caro-Vega Y, Rebeiro PF, Shepherd BE, Belaunzarán-Zamudio PF, Crabtree-Ramirez B, Cesar C, Luz PM, Cortes CP, Padget D, Gotuzzo E, McGowan CC, Sierra-Madero JG. Clinical effects of durability of immunosuppression in virologically suppressed ART-initiating persons with HIV in Latin America. A retrospective cohort study. LANCET REGIONAL HEALTH. AMERICAS 2022; 8:100175. [PMID: 35602655 PMCID: PMC9121860 DOI: 10.1016/j.lana.2021.100175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Clinical outcomes are rarely studied in virologically suppressed people living with HIV (PWH) and incomplete CD4 recovery. To explore whether time living with severe immunosuppression predict clinical outcomes better than baseline or time updated CD4, we estimated the association between cumulative percentage of time with CD4 <200 cells/μL during viral suppression (VS) (%tCD4<200), and mortality and comorbidities during 2000-2019. Methods In a retrospective cohort analysis, we followed PWH initiating ART in Latin America from first VS (HIV-RNA<200 copies/μL) to death, virological failure or loss to follow-up. We fit Cox models to estimate risk of death and/or AIDS-defining and serious non-AIDS-defining events (ADE and SNADE -cancer, cardiovascular, liver, and renal diseases) by %tCD4<200 (continuous variable). We predicted survival probabilities for each event and calculated risks of hypothetical cases of different %tCD4<200. Findings In 8,369 patients with 34·9 months of follow-up (median, IQR: 16·7, 69·1), 4,274 (51%) started ART with CD4<200 cells/μL. Median %tCD4<200 was 0% (IQR: 0, 15%). We identified 195 (2·3%) deaths and 584 (7·2%) patients with ADE/SNADE. For an increased %tCD4<200 of 15% (e.g., 15% vs. 0%), the adjusted relative hazard (aHR) of death was 1·27 (95% confidence interval [CI]: 1·19 - 1·35), of ADE/SNADE was 1·13 (95%CI: 1·09 - 1·17), of SNADE was 0·96 (95%CI: 0·89 - 1·02) and of death/ADE/SNADE was 1·11 (95%CI: 1·07 - 1·14). Estimates were similar after adjusting for time updated CD4 count. Interpretation In virologically suppressed PWH, increased time living with severe immunosuppression had an increased risk of death and ADE/SNADE in this Latin American cohort, independently of time updated CD4 count. Funding This work was supported by the NIH-funded Caribbean, Central and South America network for HIV epidemiology (CCASAnet, U01AI069923), a member cohort of the International Epidemiologic Databases to Evaluate AIDS (leDEA). This award is funded by the following institutes: Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Cancer Institute (NCI), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Mental Health (NIMH), the National Heart, Lung, and Blood Institute (NHLBI), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and the Fogarty International Center (FIC). Specific funding was provided from the Fogarty International Center (FIC) for lead author, Yanink Caro-Vega, for the Fogarty-IeDEA Mentorship Program (FIMP).
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Affiliation(s)
- Yanink Caro-Vega
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico
| | | | | | | | - Brenda Crabtree-Ramirez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico
| | | | - Paula Mendes Luz
- Instituto Nacional de Infectología Evandro Chagas, Río de Janeiro, Brasil
| | | | - Denis Padget
- Instituto Hondureño de Seguridad Social, Tegucigalpa, Honduras
| | | | | | - Juan G. Sierra-Madero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico
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Chammartin F, Lodi S, Logan R, Ryom L, Mocroft A, Kirk O, d'Arminio Monforte A, Reiss P, Phillips A, El-Sadr W, Hatleberg CI, Pradier C, Bonnet F, Law M, De Wit S, Sabin C, Lundgren JD, Bucher HC. Risk for Non-AIDS-Defining and AIDS-Defining Cancer of Early Versus Delayed Initiation of Antiretroviral Therapy : A Multinational Prospective Cohort Study. Ann Intern Med 2021; 174:768-776. [PMID: 33721519 DOI: 10.7326/m20-5226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Immediate initiation of antiretroviral therapy (ART) regardless of CD4 cell count reduces risk for AIDS and non-AIDS-related events in asymptomatic, HIV-positive persons and is the standard of care. However, most HIV-positive persons initiate ART when their CD4 count decreases below 500 × 109 cells/L. Consequences of delayed ART on risk for non-AIDS-defining and AIDS-defining cancer, one of the most common reasons for death in HIV, are unclear. OBJECTIVE To estimate the long-term risk difference for cancer with the immediate ART strategy. DESIGN Multinational prospective cohort study. SETTING The D:A:D (Data collection on Adverse events of anti-HIV Drugs) study, which included HIV-positive persons from Europe, Australia, and the United States. PARTICIPANTS 8318 HIV-positive persons with at least 1 measurement each of CD4 cell count and viral load while ART-naive (study period, 2006 to 2016). MEASUREMENTS The parametric g-formula was used, with adjustment for baseline and time-dependent confounders (CD4 cell count and viral load), to assess the 10-year risk for non-AIDS-defining and AIDS-defining cancer of immediate versus deferred (at CD4 counts <350 and <500 × 109 cells/L) ART initiation strategies. RESULTS During 64 021 person-years of follow-up, 231 cases of non-AIDS-defining cancer and 272 of AIDS-defining cancer occurred among HIV-positive persons with a median age of 36 years (interquartile range, 29 to 43 years). With immediate ART, the 10-year risk for non-AIDS-defining cancer was 2.97% (95% CI, 2.37% to 3.50%) and that for AIDS-defining cancer was 2.50% (CI, 2.37% to 3.38%). Compared with immediate ART initiation, the 10-year absolute risk differences when deferring ART to CD4 counts less than 500 × 109 cells/L and less than 350 × 109 cells/L were 0.12 percentage point (CI, -0.01 to 0.26 percentage point) and 0.29 percentage point (CI, -0.03 to 0.73 percentage point), respectively, for non-AIDS-defining cancer and 0.32 percentage point (CI, 0.21 to 0.44 percentage point) and 1.00 percentage point (CI, 0.67 to 1.44 percentage points), respectively, for AIDS-defining cancer. LIMITATION Potential residual confounding due to observational study design. CONCLUSION In this young cohort, effects of immediate ART on 10-year risk for cancer were small, and further supportive data are needed for non-AIDS-defining cancer. PRIMARY FUNDING SOURCE Highly Active Antiretroviral Therapy Oversight Committee.
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Affiliation(s)
- Frédérique Chammartin
- University Hospital Basel and University of Basel, Basel, Switzerland (F.C., H.C.B.)
| | - Sara Lodi
- Boston University School of Public Health, Boston, Massachusetts (S.L.)
| | - Roger Logan
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (R.L.)
| | - Lene Ryom
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.R., O.K., C.I.H., J.D.L.)
| | - Amanda Mocroft
- University College London, London, United Kingdom (A.M., A.P., C.S.)
| | - Ole Kirk
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.R., O.K., C.I.H., J.D.L.)
| | | | - Peter Reiss
- Amsterdam University Medical Centers, University of Amsterdam, and HIV Monitoring Foundation, Amsterdam, the Netherlands (P.R.)
| | - Andrew Phillips
- University College London, London, United Kingdom (A.M., A.P., C.S.)
| | - Wafaa El-Sadr
- ICAP at Columbia University and Harlem Hospital, New York, New York (W.E.)
| | - Camilla I Hatleberg
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.R., O.K., C.I.H., J.D.L.)
| | | | - Fabrice Bonnet
- Hôpital Saint-André and Université de Bordeaux, Bordeaux, France (F.B.)
| | - Matthew Law
- University of New South Wales Sydney, Sydney, Australia (M.L.)
| | - Stéphane De Wit
- Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium (S.D.)
| | - Caroline Sabin
- University College London, London, United Kingdom (A.M., A.P., C.S.)
| | - Jens D Lundgren
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.R., O.K., C.I.H., J.D.L.)
| | - Heiner C Bucher
- University Hospital Basel and University of Basel, Basel, Switzerland (F.C., H.C.B.)
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Chiao EY, Coghill A, Kizub D, Fink V, Ndlovu N, Mazul A, Sigel K. The effect of non-AIDS-defining cancers on people living with HIV. Lancet Oncol 2021; 22:e240-e253. [PMID: 34087151 PMCID: PMC8628366 DOI: 10.1016/s1470-2045(21)00137-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 12/31/2022]
Abstract
Non-AIDS-defining cancers are a growing source of morbidity for people with HIV globally. Although people living with HIV have a disproportionately increased risk of developing virally mediated cancers, cancer burden for common non-AIDS-defining cancers that are not virally associated and are linked to ageing, such as prostate cancer, is becoming higher than for virally mediated cancers. Ageing, behavioural, and HIV-specific factors drive the incidence and affect the outcomes of non-AIDS-defining cancers, presenting different challenges for addressing global morbidity and mortality from non-AIDS-defining cancer. Although large population-based studies have shown that people living with HIV with non-AIDS-defining cancers have poorer cancer outcomes than do people without HIV, current guidelines emphasise that people living with HIV with non-AIDS-defining cancers should receive standard, guideline-based treatment, and infectious disease and oncology providers should work closely to address potential drug interactions between antiretroviral therapy and antineoplastic treatment. Most trials target preventive measures focusing on non-AIDS-defining cancers. However, treatment trials for the optimal management of people living with HIV and non-AIDS-defining cancer, including interventions such as immunotherapies, are needed to improve non-AIDS-defining cancer outcomes.
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Affiliation(s)
- Elizabeth Y Chiao
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of General Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Anna Coghill
- Cancer Epidemiology Program, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; Center for Immunization and Infection Research in Cancer, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Darya Kizub
- Department of General Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Valeria Fink
- Clinical Research, Fundación Huésped, Buenos Aires, Argentina
| | - Ntokozo Ndlovu
- Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Angela Mazul
- Department of Otolaryngology, Washington University School of Medicine, Washington University, St Louis, MO, USA
| | - Keith Sigel
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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6
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Greenblatt R, Bacchetti P, Boylan R, Kober K, Springer G, Anastos K, Busch M, Cohen M, Kassaye S, Gustafson D, Aouizerat B. Genetic and clinical predictors of CD4 lymphocyte recovery during suppressive antiretroviral therapy: Whole exome sequencing and antiretroviral therapy response phenotypes. PLoS One 2019; 14:e0219201. [PMID: 31415590 PMCID: PMC6695188 DOI: 10.1371/journal.pone.0219201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/18/2019] [Indexed: 12/12/2022] Open
Abstract
Increase of peripheral blood CD4 lymphocyte counts is a key goal of combined antiretroviral therapy (cART); most, but not all, recipients respond adequately and promptly. A small number of studies have examined specific genetic factors associated with the extent of CD4 recovery. We report a genome-wide examination of factors that predict CD4 recovery in HIV-infected women. We identified women in in a cohort study who were on cART with viral load below 400 copies, and drew racially and ethnically matched samples of those with good CD4 response over 2 years or poor response. We analyzed the exomes of those women employing next generation sequencing for genes associated with CD4 recovery after controlling for non-genetic factors identified through forward stepwise selection as important. We studied 48 women with good CD4 recovery and 42 with poor CD4 recovery during virologically-suppressive cART. Stepwise logistic regression selected only age as a statistically significant (p<0.05) non-genetic predictor of response type (each additional year of age reduced the odds of good recovery by 11% (OR = 0.89, CI = 0.84–0.96, p = 0.0009). After adjustment for age and genomic estimates of race and ethnicity, 41 genes harbored variations associated with CD4 recovery group (p≤0.001); 5 of these have been previously reported to be associated with HIV infection, 4 genes would likely influence CD4 homeostasis, and 13 genes either had known functions or were members of product families that had functions for which interactions with HIV or effects on lymphocyte homeostasis were biologically plausible. Greater age was the strongest acquired factor that predicted poor CD4 cell recovery. Sequence variations spanning 41 genes were independently predictive of CD4 recovery. Many of these genes have functions that impact the cell cycle, apoptosis, lymphocyte migration, or have known interactions with HIV. These findings may help inform new hypotheses related to responses to HIV therapy and CD4 lymphocyte homeostasis.
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Affiliation(s)
- Ruth Greenblatt
- UCSF School of Pharmacy, Department of Clinical Pharmacy, San Francisco, CA, United States of America
- UCSF School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, United States of America
- UCSF School of Medicine, Department of Medicine, San Francisco, CA, United States of America
- * E-mail:
| | - Peter Bacchetti
- UCSF School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, United States of America
| | - Ross Boylan
- UCSF School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, United States of America
| | - Kord Kober
- UCSF School of Nursing, Department of Physiological Nursing, San Francisco, CA, United States of America
| | - Gayle Springer
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States of America
| | - Kathryn Anastos
- Albert Einstein College of Medicine and Montefiore Health Systems, Bronx, NY, United States of America
| | - Michael Busch
- UCSF School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, United States of America
- Blood Systems Research Institute, San Francisco, CA, United States of America
| | - Mardge Cohen
- Stroger Hospital, Chicago, IL, United States of America
| | - Seble Kassaye
- Georgetown University Medical Center, Department of Medicine, Washington, DC, United States of America
| | - Deborah Gustafson
- State University of New York, Downstate Medical Center, Department of Neurology, Brooklyn, NY, United States of America
| | - Bradley Aouizerat
- New York University School of Dentistry and Bluestone Center for Clinical Research, NY, NY, United States of America
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7
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Billa O, Chalouni M, Salmon D, Poizot-Martin I, Gilbert C, Katlama C, Neau D, Chas J, Morlat P, Lacombe K, Naqvi A, Barange K, Gervais A, Bouchaud O, Rosenthal E, Lascoux-Combe C, Garipuy D, Alric L, Dominguez S, Vittecoq D, Goujard C, Duvivier C, Aumaitre H, Miailhes P, Zucman D, Simon A, Lazaro E, Raffi F, Esterle L, Wittkop L, Bani-Sadr F. Factors associated with non-AIDS-defining cancers and non HCV-liver related cancers in HIV/HCV-coinfected patients- ANRS-CO13 HEPAVIH cohort. PLoS One 2018; 13:e0208657. [PMID: 30562358 PMCID: PMC6298669 DOI: 10.1371/journal.pone.0208657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/20/2018] [Indexed: 12/23/2022] Open
Abstract
Compared to the general population, HIV-infected patients are at higher risk of developing non-AIDS-defining cancers. Chronic HCV infection has also been associated with a higher risk than that of the general population of developing cancers other than hepatocarcinoma. Evaluation of the impact of HCV-related factors on non-AIDS-defining and non HCV-liver (NANL) related cancers among HIV/HCV co-infected patients are scarce. The aim of this study was to identify the impact of HIV/HCV clinical characteristics on NANL related cancers in a large cohort of HIV/HCV-coinfected patients followed from 2005 to 2017. Cox proportional hazards models with delayed entry were used to estimate factors associated with NANL related cancer. Among 1391 patients followed for a median of 5 years, 60 patients developed NANL related cancers, yielding an incidence rate of 8.9 per 1000 person-years (95% CI, [6.6–11.1]). By final multivariable analysis, after adjustment for sex, tobacco or alcohol consumption, baseline CD4 cell count and HCV sustained viral response (SVR), age and a longer duration since HIV diagnosis were independently associated with a higher risk of NANL related cancer (aHR for each additional year 1.10, 95% CI 1.06–1.14, p<0.0001 and 1.06, 95% CI 1.01–1.11, p = 0.02, respectively). Duration of HCV infection, cirrhosis, HCV viral load, genotype and SVR were not associated with the occurrence of NANL related cancer. Among HIV/HCV-coinfected patients, age and the duration of HIV infection were the only characteristics found to be associated with the occurrence of NANL related cancer. In contrast, no association was observed with any HCV-related variables.
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Affiliation(s)
- Oumar Billa
- Univ Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux, France
| | - Mathieu Chalouni
- Univ Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux, France
| | - Dominique Salmon
- Université Paris Descartes, Paris, France
- Unité Maladies Infectieuses et Tropicales- Hôpitaux Universitaires Paris Centre, APHP, Paris, France
| | - Isabelle Poizot-Martin
- Aix Marseille Université, APHM Hôpital Sainte-Marguerite, Service d’Immuno-hématologie clinique, Marseille, France
- INSERM, U912 (SESSTIM)- Marseille, France
| | - Camille Gilbert
- Univ Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux, France
| | - Christine Katlama
- Assistance Publique des Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Service Maladies infectieuses et tropicales, Paris, France
- Institut Pierre Louis Epidémiologie et Santé Publique UPMC, Sorbonne Université, Paris, France
| | - Didier Neau
- Centre Hospitalier Universitaire de Bordeaux, Service Maladies infectieuses et tropicales Bordeaux, Hôpital Pellegrin, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
| | - Julie Chas
- Assistance Publique des Hôpitaux de Paris, Hôpital Tenon, Service Maladies infectieuses et tropicales, Paris, France
| | - Philippe Morlat
- Univ Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
- Centre Hospitalier Universitaire de Bordeaux, Service de médecine interne, Hôpital Saint-André, Bordeaux, France
| | - Karine Lacombe
- Assistance Publique des Hôpitaux de Paris, Hôpital Saint-Antoine, Service Maladies infectieuses et tropicales, Paris, France
- UMR S1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
| | - Alissa Naqvi
- Centre Hospitalier Universitaire de Nice, Service d’Infectiologie, Hôpital Archet 1, Nice, France
| | - Karl Barange
- Centre Hospitalier Universitaire de Toulouse, Service Gastro-entérologie et hépatologie, Hôpital Purpan, Toulouse, France
| | - Anne Gervais
- Assistance Publique des Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Service des maladies infectieuses et tropicales, Paris, France
| | - Olivier Bouchaud
- Assistance Publique des Hôpitaux de Paris, Hôpital Avicenne, Service Maladies infectieuses et tropicales, Bobigny, France
- Université Paris 13 Nord, Bobigny, France
| | - Eric Rosenthal
- Centre Hospitalier Universitaire de Nice, Service de Médecine Interne et Cancérologie, Hôpital l’Archet, Nice, France
- Université de Nice-Sophia Antipolis, Nice, France
| | - Caroline Lascoux-Combe
- Assistance Publique des Hôpitaux de Paris, Hôpital Saint-Louis, Service des Maladies infectieuses et tropicales, Paris, France
| | - Daniel Garipuy
- Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Services des Maladies infectieuses et tropicales, Toulouse, France
| | - Laurent Alric
- Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Services de Médecine interne-Pole Digestif, Toulouse, France
- UMR 152, IRD, Université Toulouse III, Toulouse, France
| | - Stéphanie Dominguez
- Assistance Publique des Hôpitaux de Paris, Hôpital Henri Mondor, Service Immunologie clinique et maladies infectieuses, Immunologie clinique, Créteil, France
| | - Daniel Vittecoq
- Assistance Publique des Hôpitaux de Paris, Hôpital Bicêtre, Hôpitaux universitaires Paris Sud, Service Maladies infectieuses et tropicales, Le Kremlin-Bicêtre, France
- Assistance Publique des Hôpitaux de Paris, Hôpital Bicêtre, Hôpitaux universitaires Paris Sud, Service Médecine interne et Immunologie clinique, Le Kremlin-Bicêtre, France
| | - Cécile Goujard
- Assistance Publique des Hôpitaux de Paris, Hôpital Bicêtre, Hôpitaux universitaires Paris Sud, Service Médecine interne et Immunologie clinique, Le Kremlin-Bicêtre, France
| | - Claudine Duvivier
- Assistance Publique des Hôpitaux de Paris, Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants malades, Centre d’Infectiologie Necker-Pasteur, IHU Imagine, Paris, France
| | - Hugues Aumaitre
- Centre Hospitalier de Perpignan, Service Maladies infectieuses et tropicales, Perpignan, France
| | - Patrick Miailhes
- Centre Hospitalier Universitaire de Lyon, Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix Rousse, Lyon, France
| | | | - Anne Simon
- Assistance Publique des Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Département de Médecine Interne et Immunologie Clinique, Paris, France
| | - Estibaliz Lazaro
- Centre Hospitalier Universitaire de Bordeaux, hôpital Haut-Lévèque, Service de Médecine interne et Maladies Infectieuses, Pessac, France
| | - François Raffi
- CHU de Nantes, Department of Infectious Diseases, Nantes, France
- Université de Nantes, CIC 1413, INSERM, Nantes, France
| | - Laure Esterle
- Univ Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux, France
| | - Linda Wittkop
- Univ Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux, France
- CHU de Bordeaux, Pôle de Santé publique, Service d’information médicale, Bordeaux, France
| | - Firouzé Bani-Sadr
- Centre Hospitalier Universitaire de Reims, Unité des Maladies Infectieuses et Tropicales, Hôpital Robert Debré, Reims, France
- Université Reims Champagne Ardenne, EA-4684 / SFR CAP-SANTE, Reims, France
- * E-mail:
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8
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The contribution of immune activation and accelerated aging in multiple myeloma occurring in HIV-infected population. AIDS 2018; 32:2841-2846. [PMID: 30234600 DOI: 10.1097/qad.0000000000002015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: The widespread use of antiretroviral treatment results in a significant improvement in immunological condition of people living with HIV (PLWH) who nevertheless experience a significantly increased risk to develop non-Hodgkin lymphoma compared with the general population. Despite many literature observations regarding multiple myeloma in PLWH, a consensus on its relevance in HIV infection does not exist. A number of large population studies on multiple myeloma in PLWH gave contrasting results, fluctuating from increased standardized incidence ratios to the lack of observed cases of multiple myeloma. Use of antiretroviral treatment, in this context, seems to induce a slight reduction of standardized incidence ratio, although with a partial effect, especially in young patients. However, a high variability in clinical onset has been described in different reports: the only common feature of multiple myeloma in PLWH is an atypical presentation as compared with general population, with a worse prognosis in case of uncontrolled HIV infection. We identified three pathogenetic steps in the complex scenario of multiple myeloma in PLWH: first, antigenic trigger; second, persistent T cell deficiency/dysfunction; third, altered regulation of B cells. All these pathogenetic steps play a role in immunological dysregulation, leading to B cell abnormalities and hyperactivation and, finally, resulting in the development of lymphoid malignancies. HIV has a role in each one of these three steps, due to its ability to trigger and dysregulate immune system. We hypothesize that HIV could be closely implicated in the multiple myeloma development in PLWH by accelerating the carcinogenesis events in a complex and only partially understood early aging process.
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9
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Bender Ignacio RA, Lin LL, Rajdev L, Chiao E. Evolving Paradigms in HIV Malignancies: Review of Ongoing Clinical Trials. J Natl Compr Canc Netw 2018; 16:1018-1026. [PMID: 30099376 PMCID: PMC6109631 DOI: 10.6004/jnccn.2018.7064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/23/2018] [Indexed: 12/19/2022]
Abstract
This review highlights current interventional clinical trials for HIV-associated malignancies (HIVAMs), with emphasis on 4 mechanistic areas: immunomodulatory therapies and gene therapies, including immune checkpoint inhibitors; cytotoxic therapies; novel tumor-targeted and virally targeted therapies in both AIDS-defining and non-AIDS-defining cancers (NADC); and other screening or topical/ablative interventions. A search on ClinicalTrials.gov located 35 trials, including 12 immunomodulatory or gene therapy trials, 6 cytotoxic therapy trials, 10 trials of therapies with tumor or viral molecular targets, and 7 trials evaluating screening interventions or topical or ablative therapies. Study drugs, mechanisms, and outcomes of interest, including future directions, are discussed. Targeted therapies and immunotherapies address not only the tumor but underlying viral oncogens, including possible benefits on HIV-specific immunologic control. The resulting science from the trials listed in this review will provide important translational breakthroughs for people living with HIV (PLWH) and cancer. We highlight disease-specific challenges that could be addressed in future studies, including testing the safety and efficacy of cutting-edge immunotherapy and targeted treatments used in the general cancer population, and improving gaps in knowledge and practice for cancer screening and its treatment, especially in low-resource regions. Additional important considerations include identification of novel therapies for virally mediated tumors that disproportionally present in PLWH, how to treat persons with HIVAM and advanced immunosuppression, and how to comanage both diseases in antiretroviral therapy-naïve persons and those receiving care in settings where supportive therapies for hematologic toxicities and infections are limited. Current and future clinical trials should address needs of both resource-replete and -limited regions, as well as cancers that are uncommon in or respond differently to HIV-negative populations (eg, Kaposi sarcoma or anal cancer), in addition to an increased focus on NADCs not traditionally linked with HIV, such as lung or gastrointestinal tumors.
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Affiliation(s)
| | - Lilie L. Lin
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Elizabeth Chiao
- Baylor College School of Medicine
- DeBakey Veterans Affairs Medical Center, Houston, Texas
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10
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Valencia Ortega M. Malignancies and infection due to the human immunodeficiency virus. Are these emerging diseases? Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2017.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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11
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Bender Ignacio R, Ghadrshenas M, Low D, Orem J, Casper C, Phipps W. HIV Status and Associated Clinical Characteristics Among Adult Patients With Cancer at the Uganda Cancer Institute. J Glob Oncol 2017; 4:1-10. [PMID: 30241139 PMCID: PMC6181185 DOI: 10.1200/jgo.17.00112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose HIV increases cancer incidence and mortality. In Uganda, the HIV epidemic has
led to an elevated incidence of AIDS-defining cancers (ADCs) and
non–AIDS-defining cancers (NADCs). Limited information exists about
how frequently HIV infection complicates the presentation and manifestations
of cancer in sub-Saharan Africa. Methods We abstracted medical records from patients with cancer who were age 18 years
or older who registered at the Uganda Cancer Institute from June through
September 2015 to determine the burden of HIV. We used χ2
tests and generalized linear models to evaluate factors associated with HIV
positivity. A sensitivity analysis estimated HIV prevalence in those
untested. Results Among 1,137 patients with cancer, 23% were HIV infected, 48% were HIV
negative, and 29% had no recorded HIV status. Of those with recorded HIV
status, 32% were HIV positive. Forty-two percent (149 of 361 patients) with
ADCs were documented as HIV infected (51% of those with documented status)
compared with 14% (108 of 776 patients) of those with NADCs (21% of those
with documented status). In multivariable analysis, HIV infection was
associated with ADC diagnosis (adjusted prevalence ratio [aPR] compared with
NADC, 2.2; 95% CI, 1.5 to 3.0), younger age (aPR, 0.9 per decade increase;
95% CI, 0.8 to 1.0), and worse performance status scores (aPR, 1.2 per point
ECOG increase; 95% CI, 1.0 to 1.5). When sensitivity analysis accounted for
undocumented HIV status, the expected prevalence of HIV infection was 29%
(range, 23% to 32%), and almost one fourth of expected HIV cases were
undiagnosed or unrecorded. Conclusion The prevalence of HIV infection among Ugandan patients with cancer is
substantially higher than in the general population. Patients with cancer
and HIV tend to be younger and have poorer performance status. Greater
awareness of the dual burden of cancer and HIV in Uganda and universal
testing of patients with cancer may improve outcomes of HIV-associated
malignancies.
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Affiliation(s)
- Rachel Bender Ignacio
- Rachel Bender Ignacio, Corey Casper, and Warren Phipps, Fred Hutchinson Cancer Research Center; Rachel Bender Ignacio, Matine Ghadrshenas, Daniel Low, Corey Casper, and Warren Phipps, University of Washington; Corey Casper, Infectious Diseases Research Institute, Seattle, WA; and Jackson Orem, Uganda Cancer Institute, Kampala, Uganda
| | - Matine Ghadrshenas
- Rachel Bender Ignacio, Corey Casper, and Warren Phipps, Fred Hutchinson Cancer Research Center; Rachel Bender Ignacio, Matine Ghadrshenas, Daniel Low, Corey Casper, and Warren Phipps, University of Washington; Corey Casper, Infectious Diseases Research Institute, Seattle, WA; and Jackson Orem, Uganda Cancer Institute, Kampala, Uganda
| | - Daniel Low
- Rachel Bender Ignacio, Corey Casper, and Warren Phipps, Fred Hutchinson Cancer Research Center; Rachel Bender Ignacio, Matine Ghadrshenas, Daniel Low, Corey Casper, and Warren Phipps, University of Washington; Corey Casper, Infectious Diseases Research Institute, Seattle, WA; and Jackson Orem, Uganda Cancer Institute, Kampala, Uganda
| | - Jackson Orem
- Rachel Bender Ignacio, Corey Casper, and Warren Phipps, Fred Hutchinson Cancer Research Center; Rachel Bender Ignacio, Matine Ghadrshenas, Daniel Low, Corey Casper, and Warren Phipps, University of Washington; Corey Casper, Infectious Diseases Research Institute, Seattle, WA; and Jackson Orem, Uganda Cancer Institute, Kampala, Uganda
| | - Corey Casper
- Rachel Bender Ignacio, Corey Casper, and Warren Phipps, Fred Hutchinson Cancer Research Center; Rachel Bender Ignacio, Matine Ghadrshenas, Daniel Low, Corey Casper, and Warren Phipps, University of Washington; Corey Casper, Infectious Diseases Research Institute, Seattle, WA; and Jackson Orem, Uganda Cancer Institute, Kampala, Uganda
| | - Warren Phipps
- Rachel Bender Ignacio, Corey Casper, and Warren Phipps, Fred Hutchinson Cancer Research Center; Rachel Bender Ignacio, Matine Ghadrshenas, Daniel Low, Corey Casper, and Warren Phipps, University of Washington; Corey Casper, Infectious Diseases Research Institute, Seattle, WA; and Jackson Orem, Uganda Cancer Institute, Kampala, Uganda
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12
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Valencia Ortega ME. Malignancies and infection due to the human immunodeficiency virus. Are these emerging diseases? Rev Clin Esp 2017; 218:149-155. [PMID: 28874261 DOI: 10.1016/j.rce.2017.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 06/17/2017] [Accepted: 07/30/2017] [Indexed: 12/26/2022]
Abstract
Since the start of the human immunodeficiency virus (HIV) epidemic, tumour disease among patients has been significant. The collection of malignancies can be divided primarily into 2 groups: those associated with HIV (all of which are related to viral diseases) and those not associated with HIV (only some of which are associated with viral diseases). The origin of these malignancies is multifactorial, and the main causes that have led to an increase in tumour disease are immunosuppression, coinfection with oncogenic viruses and life prolongation secondary to the use of antiretroviral therapy. Establishing the general characteristics of the undiagnosed AIDS tumours is difficult, mainly because they are a highly heterogeneous group formed by malignancies of a diverse nature. The treatments do not differ from those used in the general population, although the management can be more difficult due to the late diagnosis, drug interactions and associated comorbidities.
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Affiliation(s)
- M E Valencia Ortega
- Servicio de Medicina Interna-Unidad de VIH, Hospital Universitario La Paz, Madrid, España.
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13
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Abstract
PURPOSE OF REVIEW To review the newest research about the effects of combination antiretroviral therapy (cART) on cancer risk. RECENT FINDINGS HIV+ persons are at increased risk of cancer. As this risk is higher for malignancies driven by viral and bacterial coinfections, classifying malignancies into infection-related and infection-unrelated has been an emerging trend. Cohorts have detected major reductions in the incidence of Kaposi sarcoma and non-Hodgkin lymphoma (NHL) following cART initiation among immunosuppressed HIV+ persons. However, recent randomized data indicate that cART reduces risk of Kaposi sarcoma and NHL also during early HIV infection before overt immunosuppression occurs. Long-term effects of cART exposure on cancer risk are not well defined; according to basic and epidemiological research, there might be specific associations of each cART class with distinct patterns of cancer risk. SUMMARY The relationship between cART exposure and cancer risk is complex and nuanced. It is an intriguing fact that, whether initiated during severe immunosuppression or not, cART reduces risk of Kaposi sarcoma and NHL. Further research should identify mediators of the benefit of immediate cART initiation in reducing cancer risk, understand the relationship between long-term cART exposure and cancer incidence and assess whether adjuvant anti-inflammatory therapies can reduce cancer risk during treated HIV infection.
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Affiliation(s)
- Álvaro H Borges
- Centre for Health and Infectious Diseases Research, Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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14
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Salinas JL, Rentsch C, Marconi VC, Tate J, Budoff M, Butt AA, Freiberg MS, Gibert CL, Goetz MB, Leaf D, Rodriguez-Barradas MC, Justice AC, Rimland D. Baseline, Time-Updated, and Cumulative HIV Care Metrics for Predicting Acute Myocardial Infarction and All-Cause Mortality. Clin Infect Dis 2016; 63:1423-1430. [PMID: 27539575 DOI: 10.1093/cid/ciw564] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/05/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND After adjustment for cardiovascular risk factors and despite higher mortality, those with human immunodeficiency virus (HIV+) have a greater risk of acute myocardial infarction (AMI) than uninfected individuals. METHODS We included HIV+ individuals who started combination antiretroviral therapy (cART) in the Veterans Aging Cohort Study (VACS) from 1996 to 2012. We fit multivariable proportional hazards models for baseline, time-updated and cumulative measures of HIV-1 RNA, CD4 counts, and the VACS Index. We used the trapezoidal rule to build the following cumulative measures: viremia copy-years, CD4-years, and VACS Index score-years, captured 180 days after cART initiation until AMI, death, last clinic visit, or 30 September 2012. The primary outcomes were incident AMI (Medicaid, Medicare, and Veterans Affairs International Classification of Diseases-9 codes) and death. RESULTS A total of 8168 HIV+ individuals (53 861 person-years) were analyzed with 196 incident AMIs and 1710 deaths. Controlling for known cardiovascular risk factors, 6 of the 9 metrics predicted AMI and all metrics predicted mortality. Time-updated VACS Index had the lowest Akaike information criterion among all models for both outcomes. A time-updated VACS Index score of 55+ was associated with a hazard ratio (HR) of 3.31 (95% confidence interval [CI], 2.11-5.20) for AMI and a HR of 31.77 (95% CI, 26.17-38.57) for mortality. CONCLUSIONS Time-updated VACS Index provided better AMI and mortality prediction than CD4 count and HIV-1 RNA, suggesting that current health determines risk more accurately than prior history and that risk assessment can be improved by biomarkers of organ injury.
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Affiliation(s)
- Jorge L Salinas
- School of Medicine.,Rollins School of Public Health, Emory University
| | - Christopher Rentsch
- Atlanta Veterans Affairs Medical Center, Georgia.,West Haven Veterans Administration Medical Center.,Yale University Schools of Medicine and Public Health, New Haven, Connecticut
| | - Vincent C Marconi
- School of Medicine.,Rollins School of Public Health, Emory University.,Atlanta Veterans Affairs Medical Center, Georgia
| | - Janet Tate
- West Haven Veterans Administration Medical Center.,Yale University Schools of Medicine and Public Health, New Haven, Connecticut
| | - Matthew Budoff
- Veterans Affairs Greater Los Angeles Health Care System and David Geffen School of Medicine at University of California-Los Angeles, California
| | - Adeel A Butt
- University of Pittsburgh School of Medicine and VA Pittsburgh Healthcare System, Pennsylvania.,Weill Cornell Medical College, Doha, Qatar and New York City.,Hamad Healthcare Quality Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Cynthia L Gibert
- Wasington DC VA Medical Center and George Washington University School of Medicine, Washington D.C
| | - Matthew Bidwell Goetz
- Veterans Affairs Greater Los Angeles Health Care System and David Geffen School of Medicine at University of California-Los Angeles, California
| | - David Leaf
- Veterans Affairs Greater Los Angeles Health Care System and David Geffen School of Medicine at University of California-Los Angeles, California
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Amy C Justice
- West Haven Veterans Administration Medical Center.,Yale University Schools of Medicine and Public Health, New Haven, Connecticut
| | - David Rimland
- School of Medicine.,Atlanta Veterans Affairs Medical Center, Georgia
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15
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Riedel DJ, Tang LS, Rositch AF. The role of viral co-infection in HIV-associated non-AIDS-related cancers. Curr HIV/AIDS Rep 2016; 12:362-72. [PMID: 26152660 DOI: 10.1007/s11904-015-0276-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
HIV-infected individuals are at increased risk for most types of cancer, including those typically classified as non-AIDS-defining cancers (NADCs). This increased risk is likely multifactorial, but a prominent risk factor for the increased rate of some cancers is co-infection with oncogenic viruses. Anal cancer, hepatocellular carcinoma, and Hodgkin lymphoma are three of the most common NADCs, and they are associated with co-infection with human papillomavirus, hepatitis B and C, and Epstein Barr virus, respectively. This review will examine the epidemiology, pathogenesis, and future trends around these virally associated NADCs frequently found in HIV-infected individuals.
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Affiliation(s)
- David J Riedel
- Institute of Human Virology and Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD, USA,
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16
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Abstract
Pulmonary malignancies are a major source of morbidity and mortality in HIV-infected persons. Non-AIDS-defining lung cancers (mostly non-small cell lung cancers) are now a leading cause of cancer death among HIV-infected persons. HIV-associated factors appear to affect the risk of lung cancer and may adversely impact cancer treatment and outcomes. HIV infection also may modify the potential harms and benefits of lung cancer screening with computed tomography. AIDS-defining lung malignancies include pulmonary Kaposi sarcoma and pulmonary lymphoma, both of which are less prevalent with widespread adoption of antiretroviral therapy.
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Affiliation(s)
- Keith Sigel
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert Pitts
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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17
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Meernik C, Soliman AS, Ngoma T, Kahesa C, Mwaiselage J, Merajver SD. The changing pattern of ano-rectal cancer, squamous cell carcinoma of the eye, and Hodgkin's lymphoma as non-AIDS-defining cancers, by HIV status, in Tanzania over 11 years (2002-2012): a retrospective case-report study. Infect Agent Cancer 2014; 9:42. [PMID: 25926865 PMCID: PMC4414437 DOI: 10.1186/1750-9378-9-42] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/03/2014] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In Tanzania, 5.1% of adults aged 15-49 are infected with HIV. While rates of HIV-related malignancies have declined globally with antiretroviral therapy (ART), including Tanzania, rates of non-AIDS-defining cancers (NADCs) are believed to have increased. Therefore, we determined trends of three NADCs in Tanzania: ano-rectal cancer, squamous cell carcinoma of the eye, and Hodgkin's lymphoma. METHODS This study was conducted at the Ocean Road Cancer Institute (ORCI) in Dar es Salaam. All medical records of patients diagnosed with ano-rectal cancer, squamous cell carcinoma of the eye, and Hodgkin's lymphoma between 2002 and 2012 were reviewed regarding HIV status, cancer clinical characteristics and management. Analysis was conducted to determine trends and proportions in these three NADCs and patient characteristics. RESULTS We identified 980 NADCs. The relative proportion of these three NADCs at ORCI out of all cancers treated increased from 2.37% in 2002 to a peak of 4.34% in 2009. The prevalence of HIV in patients diagnosed with these NADCs also increased-from 6.67% in 2002 to 20.87% in 2010-and 85% of squamous cell carcinoma of the eye cancer patients with a reported HIV status were HIV-positive. CONCLUSIONS The frequency and proportions of these three NADCs in Tanzania have increased over the past 11 years, as has the prevalence of HIV positivity amongst these NADC patients. The current and possibly increasing burden of NADCs in Tanzania and other low- and middle-income countries with high HIV rates should be a focus for future cancer prevention and control and HIV therapy programs.
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Affiliation(s)
- Clare Meernik
- />Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI USA
| | - Amr S Soliman
- />Department of Epidemiology, University of Nebraska Medical Center College of Public Health, Omaha, NE USA
| | - Twalib Ngoma
- />Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | | | | | - Sofia D Merajver
- />Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI USA
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